NAD+ Cellular Energy Restoration Protocol

* NAD+ is a small-molecule coenzyme, not a peptide. Poor oral bioavailability necessitates parenteral delivery.

Timing · Administer in morning or early afternoon to avoid insomnia. Always co-administer methyl donors (TMG or methylated B-complex) to offset methyl-group depletion. Slow IV rate immediately if patient reports chest pressure, flushing, or cramping.

• PARP inhibitors (olaparib, niraparib)— Mechanistic antagonism — NAD+ restores the substrate these drugs depleteAVOID
• Active chemotherapy— Theoretical tumor support via PARP-mediated DNA repair; coordinate with oncologyAVOID
• Methotrexate / antifolates— Shared methyl-group demand; monitor homocysteineMONITOR
• MAO inhibitors / stimulants— Theoretical additive catecholaminergic effect; start lowMONITOR
• Methylene blue— Both affect mitochondrial electron transport; potential additive effectMONITOR
• Glutathione IV— Commonly co-administered for redox and detoxification supportSYNERGISTIC
• BPC-157— Complementary mitochondrial and tissue repair pathwaysSYNERGISTIC
• Semax / Selank— Often stacked for cognitive and SUD recovery applicationsSYNERGISTIC
• Methylated B-complex / TMG— Required co-supplementation to prevent methyl-group depletionSYNERGISTIC

1. 1

   Confirm vial label, strength (1000 mg or 500 mg), and expiration date.

2. 2

   Wipe vial stopper and bacteriostatic water (BAC) vial with separate alcohol swabs.

3. 3

   For IV: draw NAD+ 1000 mg into 250–500 mL of 0.9% normal saline bag.

4. 4

   For SC: reconstitute 500 mg vial with 2–3 mL bacteriostatic water; inject diluent slowly down vial wall.

5. 5

   Gently swirl — do not shake — until fully dissolved. Solution should be clear to pale yellow.

6. 6

   Inspect for particulate matter or discoloration; discard if present.

7. 7

   For IV: prime tubing, attach to indwelling IV access, and start at slow rate (e.g., 25 mL/hr) for first 15 minutes.

8. 8

   Titrate IV rate upward as tolerated; total infusion typically 2–4 hours. Slow immediately if symptoms emerge.

9. 9

   For SC: draw target dose into insulin syringe; rotate sites between abdomen and thigh.

10. 10

    Inject SC slowly over 10–20 seconds to reduce stinging; warming the syringe to room temperature improves tolerance.

11. 11

    Label reconstituted SC vial with date; store refrigerated and use within 30 days.

12. 12

    Document dose, rate, site, and any adverse reactions in patient record.

• ✓

  Clear to pale yellow solution

  Properly reconstituted NAD+ should be transparent; deeper yellow or amber indicates oxidation.

• ✓

  Full dissolution within 60 seconds

  Powder should dissolve readily with gentle swirling.

• !

  Mild stinging on SC injection

  Common and transient; mitigated by room-temperature solution and slow injection.

• ✕

  Particulate matter or cloudiness

  Discard immediately — may indicate contamination or degradation.

• ✕

  Brown discoloration

  Indicates significant oxidation; do not administer.

• First infusion often produces transient chest tightness or flushing — slow the drip and these resolve

• Most patients report improved energy and mental clarity within 1–4 weeks of loading

• Sleep quality often improves; mood stabilization common in SUD recovery context

• SC injection sites may show erythema or induration lasting hours — rotate sites

• Cognitive metrics (processing speed, working memory) typically improve by week 8

• Homocysteine may rise without adequate methyl donor co-supplementation

• Non-responders are usually identifiable by week 4–6; escalation rarely changes outcome

• Some patients describe improvements in skin quality and hair regrowth at 12 weeks

• Inter-individual variability is substantial; track subjective and objective metrics

• Late-day dosing can cause insomnia — administer morning or early afternoon